Outcome of Posterior Stabilisations for Metastatic Spinal Lesions

Abstract

Introduction The objective of this study was to determine whether posterior only stabilization of metastatic spinal lesions provides adequate stability over the life span of the recipient patient. There are no gold standards for surgical stabilization of metastatic spinal lesions however National Institute of Clinical Excellence guidelines (UK) state that anterior reconstruction should be considered in patients with metastatic spinal cord compression who are likely to survive a year. Standard practice in our regional unit has been to stabilize metastatic spinal lesions through a posterior only approach. Our rationale is that posterior stabilization provides sufficient stability while avoiding the additional risks, time, and cost of anterior stabilization. Materials and Method Retrospective review of all cases of posterior only spinal stabilization performed for metastatic disease over a 5 year period. Patient demographics, pathology and metal work construct including number of levels stabilized was recorded. All post-operative imaging was reviewed. Failures and revisions were recorded. Clinical notes were reviewed for surviving patients. Results Of the 94 cases 49 were male, average age at time of surgery was 62. 77 (81.9%). Of the patients who were deceased by the study end date mean time from surgery to death was 504 (15 to 1865) days. 72 (93.5%) of constructs remained stable until death. 5 patients required further surgery. 3 had broken rods requiring revision and 2 required anterior decompression and stabilization for disease progression. None of the 17 alive patients required further surgery and all remained neurologically intact. Conclusion This case series revealed very low rates of posterior construct failure or need for further surgery for disease progression. This indicates that posterior only stabilization is a safe and effective surgical management option for metastatic spinal lesions.